ABSTRACT: The health beliefs and psychological status of 20

vegetarians were assessed with eight different psychometric tests.

Although the group demonstrated elevated somatic concerns on the

Hopkins Symptom Checklist (HSCL-90) and the Illness Behavior

Questionnaire (IBQ), it did not differ from control populations on

other dimensions of psychopathology. The subjects cited healthconcerns as the primary reason for avoiding meat products. Theydisplayed a generally positive attitude toward modern medicine. Theimplications of these findings as compared with those of previoussurveys of vegetarians are discussed.

From the departments of psychiatry and medicine, The Fairfax Hospital and the

Georgetown University School of Medicine. Reprint requests to Dr. Wise, Department of

Psychiatty, The Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22046.

CHARLES K. COOPER

JUNE 1985’V0L26#{149}N06 521

ThOMAS N. WISE, M.D.

LEES. MANN, M.A.

Psychological and cognitivecharacteristics of vegetarians

During the past decade, increasingnumbers of individuals have adoptedvegetarian dietary patterns. Religious

prohibitions, cultural beliefs, health

benefits, and counterculture attitudes

have been cited as primary reasons forsuch a diet, which departs from the

Western tradition of meat intake. Al-though previous reports have studiedfactors leading to the adoption of veg-

etarianism, little objective data are

available to describe the psychologi-

cal or cognitive characteristics of such

persons.’ To our knowledge, this

study is the first to describe the objec-

tive psychological characteristics of agroup of vegetarians.

Investigational procedure

Twenty subjects were recruited to par-ticipate in this study by means of ad-vertisements placed in local health

food stores and community news-papers. All of them filled out a ques-tionnaire pertaining to demographiccharacteristics, the rationale for di-

etary habits, attitudes about health be-

liefs, and the utilization of various

nontraditional health providers.

They then completed a battery ofpsychometric inventories for the fol-

lowing purposes. The HSCL-9(Y as-

sesses psychological distress along

nine primary dimensions. The IBQ3

measures attitudes that suggest map-

propriate or maladaptive modes of re-

sponding to one’s state of health. The

specific dimensions include general

hypochondriasis, disease conviction,psychological vs somatic concerns,

affective inhibition, dysphoria, deni-

al, and irritability. The Eysenck Per-sonality Inventory (EPI)4 measures

personality in terms of two indepen-dent dimensions: extroversion-intro-version and neuroticism-stability. TheBuss-Durkee Inventory5 evaluateshostility.

Two measures of cognitive style

were utilized. The Rotter Locus ofControl (LOC) scale6 quantifies theperson’s concept of control over his or

her fate. It identifies an individual ei-

ther as externally located, denoting

belief in little control over one’s future

and dependence on surroundingforces, or as internally controlled,with a sense of self-reliance and beingable to influence one’s future. The

Table 1-Characteristics of theStudy Group of Vegetarians (N = 20)

Mean age, yr

Male(N = 8)

Marital statusSingleMarried

Female(N=12)

28 (SD, 3.8) 27.2 (SD, 4.2)

26

EducationThrough high schoolCollege graduate

84

26

7

Body Mass Index (wt/ht2)* 23.2 (SD, 1.73)‘The normal values for men are 20 to 25; for women, 19 to 24.11

5

20.3 (SD, 2.18)

Vegetarians

522 PSYCHOSOMATICS

Portable Rod and Frame Test7 assesses

cognitive style in the form of psycho-

logical differential, ie, field depen-

dency or independency. Specifically,

more structured analytic defenses

such as isolation and intellectualiza-

tion correlate with the field-indepen-

dent person, whereas denial and

repression correlate with the undiffer-

entiated field-dependent style. These

latter two variables, locus of control

and field dependency or independen-

cy, are not measures of psychopathol-

ogy but are indicators of cognitive

styles.4

Eating Attitudes Test (EAT)’ mea-

sures the kind of eating behaviors and

related cognitions that are often seen

in anorexic women. The Hysteroid-

Obsessoid Questionnaire (HOQ)’

measures personality traits, based on

the assumption that hysterical and ob-sessional features represent a continu-

urn, which can be scored. Specific

traits for the hysterical pole ofthe con-

tinuum include attention-seeking and

frequency of mood change, while theobsessoid pole is characterized by

conscientiousness and minimal fan-

tasy production.

The data were organized and ana-lyzed using summary statistics, two-

tailed t tests for group mean compari-

sons, and Pearson correlation coeffi-

cients.’#{176}The control groups consisted

of samples studied with each instru-

ment and whose scores were reportedin the manual for that particular test.

Results

Beliefs and behaviors. The study

group consisted of well-educated

young adults of normal weight” who

had been vegetarians for an average of

9.0 years (SD, 6.0); see Table 1. They

cited multiple reasons for having

adopted a vegetarian diet. Thirteen

(65%) mentioned health concerns as a

reason for their dietary preferences.Twelve (60%) noted the desire to

avoid cruelty to animals as a reason

and ten (50%) disliked the eating of

animal flesh. Eight (40%) spoke of

fear of a world food shortage as a rea-

son for their vegetarianism, while

only three (15%) said that meat tasted

bad to them. Two had adopted a vege-

tarian diet owing to the influence oftheir spouses. All members of the

group were native-born Americans

and none had adopted vegetarianism

for religious reasons.

They had learned about vegetarian-

ism from a variety of sources: friends

(40%), family (30%), health food

stores (10%), and from their own in-

quiries (50%). Seventeen (85%) of the

group never ate poultry, 13 (65%) ab-

stained from fish, four (20%) did not

eat eggs, and only two (10%) did not

eat cheese or milk. All of them wore

clothes containing wool and could not

be classified as strict vegetarians, who

do not use clothing, footwear, or

household furnishings derived from

animals. All subjects used products

containing caffeine. All said that they

would eat only in specific restaurants

and were very vigilant about any

meals or packaged foods that might

have meat by-products in them.

Seventeen of the group reported

that friends and family either agreed

with their dietary approach or did not

care. Only two thought that their par-

ents disagreed with vegetarianism,

and one noted that a friend had corn-

mented negatively on his choice of

diet. Use of a visual analogue scale,

with 0 denoting ‘ ‘total agreement”

that modern medicine is useful and

100 meaning ‘ ‘total disagreement,”

produced an average for the group of

29.6 mm (SD, 33.2). Only two re-

spondents had seen a nutritionist and

one had sought advice from a herbal

doctor. However, eight had tried yoga

and six had practiced transcendental

meditation. Four had utilized acu-

puncture, and five had tried a macro-

biotic diet in the past. Seventeen were

presently taking vitamins.

Recreational drugs were infre-

quently used. Eleven subjects had

tried marijuana, yet only two used it

more than once a week. Seven had

taken LSD and four phencyclidine,

but none had ever used those drugs

regularly. Seventeen had used alco-

hol, but only seven took more than one

drink per week.

Eight (40%) of the group had

Table 2-Scores on the Hopkins Symptom Checklist forthe Vegetarians, and the Significance of Differences

from Scores Reported* for iWo Control Groups

Vegetarians(N =20)

Normalcontrols(N=947)

Somatization

PsychiatricoutpatIents

(N = 1002)

Obsessive-compulsive

Mean SD Significance of dIfference

.56 .50 P<.05

.86 .61 P<.001

NS

Interpersonalsensitivity

Depression

Anxiety

Hostility

Phobic anxiety

P<.o1

1.01

.96

.65

.62

.28

.85 P<.0O1

.78 P<.001

.53 P<.001

.71 P<.O01

.43 NS

Paranoid ideation

NS

P<.001

P<.001

P<.05

P<.02

.78

Psychoticism

.69 P<.001

.55 .56 P<.001

‘Scores for the control groups as reported by Derogatis et at.’2

NS

P<.05

Table 3-Scores for the Vegetarian Group(N = 20) on Seven Psychometric Inventories

Illness Behavior Questionnaire

Mean

Eysenck Personality Inventory

SD

1 .90’ (generalhypochondriasis)

1.76

Hostility Inventory

12.95 (extroversion)’1 1 .85 (neuroticism)

1 .50 (lie scale)

Hysteroid-ObsessoidQuestionnaire

27.00

3.12

5.091.19

Locus of Control Scale

Rod and Frame Test

25.85

11.20

5.76

Eating Attitudes Test

10.80

d’ 1.71 (field9 3.1 7 dependency)

18.36’

4.47

1.502.46

‘Scores significantly (P<.02 for general hypochondriasis, P< .01 for the remaining itemswith an asterisk) different from those of control populations, as reported in the manualsfor the particular test.

6.65

JUNE 1985#{149}V0L26’N06

sought psychiatric care in the past. For

seven of them, depression and inter-

personal difficulties had prompted re-

course to treatment; one person had

taken a drug overdose. Fifteen sub-

jects (75%) believed that they were in

the proper weight range; four thought

themselves overweight; and one felt

too thin. Those thinking that they wereoverweight were in fact found to be

within normal limits.”

Psychometric testing. The scores

on the HSCL-90 reflected the fact that

the vegetarians reported more symp-

tomatology than did a normal control

group but less than a group of psychi-

atric outpatients’2 (Table 2). These

scores for the vegetarians document

some emotional distress but not in a

range comparable to thatofa psychiat-

nc population. The IBQ scores

showed that general hypochondriacal

concerns were significantly (P< .02)

more marked than for a control group

of family practice patients, but the re-

maining dimensions of disease con-

viction, psychological vs somatic con-

cern, affective inhibition, dysphoria,

denial, and irritability were not signif-

icantly different. Mean scores for the

vegetarians for general hypochondria-

sis on the IBQ and on the remaining

six inventories are shown in Table 3.

The EPI results showed the study

group to be more introverted on the

Extroversion Scale but not to differ

from a control population in regard to

neuroticism. The Hostility Inventory

revealed the vegetarians to have no

more hostility than a normal control

group. On the HOQ the group mean

was approximately midway between

the hysteroid and obsessoid poles.

Their locus of control did not differ

significantly from that of a normative

adult population, while they were sig-

nificantly (P<.0l) more field-inde-

pendent and analytic in style on the

rod and frame test than controls.’3”4

Eating behavior patterns of the female

(continued)

523

526 PSYCHOSOMATICS

Restoril �

(temazepam)cOne 30 mg capsule, h.s.-usual adult dosage.Onel5 mg capsule, h .s.-recommendedinitialdosage forelderly and/or debilitated patients.INDICATIONSAND USAGE: Restorit#{174}(temazepam) is mdi-cated for the relief of insomnia associated with complaintsof difficulty in falling-asleep, frequent nocturnal awaken-ings, and/or early morning awakenings. Since insomniais often transient and intermittent, the prolonged admmn-istration of Restoril is generally not necessary orrecommended. Restoril has been employedfor sleep main-tenance for up to 35 consecutive nights of drugadministration in sleep laboratory studies.

The possibility that the insomnia may be related to acondition for which there is more specifictreatment shouldbe considered.CONTRAINDICATIONS: Benzodiazepines may cause fetaldamage when administered during pregnancy. An in-creased risk of congenital malformations associated withthe use of diazepam and chlordiazepoxide during the firsttrimester of pregnancy has been suggested in several stud-les. Also,ingestion oftherapeutic doses of benzodiazepinehypnoticsduring the last weeks of pregnancy has resultedin neonatal CNS depression. Restoril (temazepam) is con-traindicated in pregnant women. Consider a possibility ofpregnancy when instituting therapy or whether patient in-tends to become pregnant.WARNINGS: Patients receiving Restoril (temazepam)should be cautioned about possible combined effects withalcohol and other CNS depressants.PRECAUTiONS: In elderly and/or debilitated patients, it isrecommended that initial dosage be limited to 15 mg. Theusual precautions are indicated for severely depressed pa-tients or those in whom there is any evidence of latent de-pression; it should be recognized that suicidal tendenciesmay be presentand protective measures may be necessary.

If Restoril is to be combined with other drugs havingknown hypnotic properties or CNS-depressanteffects, dueconsideration should be given to potential additive effects.Information for Patients: Patients receiving Restorilshould be cautioned about possible combined effects withalcohol and other CNS depressants. Patients should becautioned notto operate machinery or drive a motor vehi-cle. They should be advised of the possibility of disturbednocturnal sleep forthefirstor second nightafter discontin-uing the drug.Laboratory Tests: The usual precautions should be ob-served in patients with impaired renal or hepatic function.Abnormal liver function tests as well as blood dyscrasiashave been reported with benzodiazepines.Pregnancy: Pregnancy Category X. See Contraindica-tions.Pediatric Use: Safety and effectiveness in children belowtheageofl8 years have not been established.ADVERSE REACTIONS: The most common adverse reac-tions were drowsiness, dizziness and lethargy. Other sideeffects include confusion, euphoria and relaxed feeling.Less commonly reported were weakness, anorexia and di-arrhea. Rarely reported weretremor, ataxia, lackofconcen-tration, loss of equilibrium, falling and palpitations. Andrarely reported were hallucinations, horizontal nystagmusand paradoxical reactions, including excitement, stimula-tion and hyperactivity.

Restoril (temazepam) is a controlled substance inSchedule IV. Caution must be exercised in addiction-proneindividuals or those who might increase dosage.DOSAGE AND ADMINISTRATiON: Adults: 30 mg usualdosage before retiring; 15 mg may suffice in some. Elderlyand/ordebilitated: 15 mg recommended initially until mdi-vidual response is determined.SUPPLIED: Restoril (temazepam) capsules-15 mg ma-roon and pink, imprinted “RESTORIL 15 mg’; 30 mg,maroon and blue, imprinted “RESTORIL 30 mg’. Pack-ages of 100, 500 and ControlPak� packages of 25 capsules(continuous reverse-numbered roll of sealed blisters).Sizes and strengths available to Armed Services: Restoril(temazepam) capsules, in bottles of 500: 1� mg cap-sules NSN/6505-O1-116-0481; 30 mg capsulesNSN/6505-O1-116-0482. (RES-Z3 3/15/83)

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Vegetarians

vegetarians differed significantly

(P<.01) from those of an anorexic

population.

Analyses of variance were per-

formed for subsets of the vegetarian

study group to ascertain whether there

were significant test differences

between persons who completely

avoided fish and poultry and those

who occasionally ate such food. No

such differences were revealed by any

dimensions of the HSCL-90, IBQ,

EPI, HOQ, or the LOC.Examination for correlation

between specific variables showed

that a tendency toward a hysteroid

style related significantly (r= .53;

P<.03), and that the somatization

subscale of the HSCL-90 correlated

significantly (r .46; P< .03) with the

general hypochondriasis dimension of

the IBQ. An increasing feeling of hos-

tility on the Hostility Inventory corre-

lated significantly (r .49; P< .03)with an increasing external locus of

control. No significant correlation

was found between increasing field

dependency and a hysteroid style,

between field dependency and locusof control, or between a hysteroidstyle and increasing hostility.

Discussion

The study group in this report is simi-

lar to those in other surveys’5 of vege-

tarianism in the United States, in that

the subjects were young and well-edu-

cated adults. The present group’s cit-

ing of health concerns as the majorfactor in the choice of vegetarianism

accords with previous surveys in this

country. However, in the United

Kingdom respondents have men-

tioned” avoidance of cruelty to ani-mals as the primary reason for not us-

ing animal products. Surveys’7 in bothcountries reveal emphasis on meta-

physical health beliefs as one element

of various counterculture philoso-

phies that vegetarians endorse. Al-

though our subjects frequently uti-

lized meditation practices, they gener-

ally manifested a positive attitude

toward modern medicine and rarely

resorted to nontraditional healers. The

minimal use of drugs and alcohol did

not support a finding” that vegetarians

have been actively involved with the

drug culture and have adopted their

diet as a reaction to such behavior.

The psychometric findings pointedto the group’s concern with physical

status and bodily symptoms. The con-

firmation that the group as a whole

was markedly field-independent in

cognitive style is noteworthy. An ana-

lytic style is needed if one is to main-

tam a vegetarian diet. Subjects fre-

quently mentioned the need for vigi-

lance, so as to avoid meat products.

They did not display a specific charac-

terologic style such as hysterical or

obsessional. Although as a group they

were found on the EPI to be more in-

troverted, their basic similarity to a

normal population supports Lester’s

‘9 that persons associatedwith food fads or food cults did not

display differences on the EPI.

On the whole, the group was moresymptomatic than a normal popula-

tion, as reflected by higher scores on

HSCL-90, but they were less symp-tomatic than a psychiatric population.

The 12 women did not have anorexic

eating patterns. Isolated case reports�#{176}

in the psychoanalytic literature have

noted vegetarians to display increased

oral aggression. This study does not

confirm that. The correlations

between hostility and external locus of

control may reflect the rigors of avoid-

ing meat among a primarily carnivo-

rous population.

One explanation for the above find-ings is that vegetarians are acutely

aware of physical health and bodily

messages. They actively cope with

these concerns by adopting what they

perceive to be the most healthy diet. A

New books received

Saunders Dictionary& Encyclopedia of LaboratoryMedicine and Technologyedited by James L. Bennington,Philadelphia, WB. Saunders, 1984,1,700 pp, $45.00 (softcover).

Psychiatry: Specialty BoardReview, ed 3by Namir F. Damlouji. John P.Feighner, and Marc A. Schuckit,New Hyde Park, NY, Medical Ex-amination Publishing, 1983, 246pp, $26.50 (paperback).

Rehabilitation Psychology:A Comprehensive lbxtbookby David W. Krueger, Rockville,Md., Aspen Systems Corp., 1984,406 pp. $31.

1983 Year Book of Psychiatryand Applied Mental Healthby Daniel X. Freedman, LawrenceC. Kolb, Reginald S. Lourie, Her-bert Y. Meltzer, John C. Nemiah,and Herbert Weiner, Chicago, YearBook Medical Publishers, 1983,380 pp, $39.95.

Visualization: The Uses ofImagery in the HealthProfessionsby Errol R. Korn and Karen John-son, Homewood, Ill. Dow Jones-Irwin, 1983, 219 pp, $29.50.Pathological Play in Borderline

and Narcissistic Personalitiesby Irving Steingart, Jamaica, N.Y.,SP Medical & Scientific Books,1983, 139 pp, $24.95.

Functional GastrointestinalDisorders: A BehavioralMedicine Approachby Paul Latimer, New York, Sprin-ger Publishing, 1983, 174 pp.$23.95.

The Denial of Stressedited by Shlomo Breznitz, NewYork, International UniversitiesPress, 1983, 316 pp, $25.

The Handbook of ClinicalPsychology: Theory,Research, and Practiceby C. Eugene Walker,Homewood, Ill. Dow Jones-Irwin,1983, 2 vols. 1439 pp, each $40.

Advances In BiologicalPsychiatry: BiologicalRhythms and Behavioredited by J. Mendelwicz, N. M.Van Praag, Basel, Switzerland, S.Karger, 1983, 150 pp, $59.50(paperback).

JUNE 1985#{149}VOL2#{212}#{149}N06 527

vegetarian diet appropriately supple-

mented with vitamins has been

shown2’ to be advantageous in reduc-

ing coronary artery disease and lower-

ing serum cholesterol. Our study did

not apply depth psychology to ascer-

tam why vegetarian beliefs and prac-

tices had been adopted. However, it

does suggest that vegetarians as a

group show minimal deviations from

normal controls on psychometric test-

ing. Previous reports indicating such

persons to be impaired psychological-

ly, or deviant, must be reconsidered.

Although small, this study presents

evidence that this alternative dietary

style does not necessarily coexist with

psychopathology. U

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3 Pilowsky I, Spence ND: Manual for the Illness

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